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Ophthalmology and Optometry Coding Alert

CPT® 2012 Update:
0289T, 0290T Shape Your Options for Intralase-Assisted Keratoplasty
Use two new temp codes to represent the emerging laser corneal incision technology. If you... Read more
ICD-10 Countdown:
Get Ready or Get Fined -- That's the CMS Message
Explore 6 FAQs to ramp up your ICD-10 coding know-how.Denials aren't the only thing you ha... Read more
Diagnosis Coding:
6 Tips Help Keep Your ICD-9 Coding on Track
Cheat sheets come with a warning label.To help ensure your coding complies with ICD-9 guid... Read more
Visual Fields:
92081-92083 With Modifier 50? Not So Fast
Careful with those modifiers and dx codes, or you could be heading towards VF denials. ... Read more
Reader Question:
92285 Requires 'Track or Treat' Evidence
Question: Our ophthalmologist performs external ocular photography for a Medicare patient ... Read more
Reader Question:
92225-92226: Apply Initial EO Code to New Condition
Question: I'm confused about the extended ophthalmoscopy codes. Is 92225 for a new p... Read more
Reader Question:
68761 With E/M? Check Documentation First
Question: When my ophthalmologist does a comprehensive exam (92004) and decides to insert ... Read more
Reader Question:
Specify Refraction Exclusion to Clarify ABN Confusion
Question: Are patients undergoing keratoconus workup or contact lens fitting still require... Read more
You Be the Coder:
Cataract Removal With Pupil Stretching
Question: Our ophthalmologist wants me to submit a claim for 66982, along with stre... Read more
YAG Procedures:
66821 Essentials: Break YAG Capsulotomies From Cataract Globals
Heed these documentation and modifier tips to ethically earn an extra $160 for after-catar... Read more
ICD-10 Bridge
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be differe... Read more
Lens Services:
92070 With 371.6x Focuses on Medical Necessity for Fitting Keratoconic Lenses
Follow this strategy and earn $67 for each contact lens procedure.You know you can't bill ... Read more
Part B Updates:
Vendor Won't Be Ready for 5010? Get Claims in Before 2011 Ends, CMS Advises
Plus: E-prescribing hardship exemptions are due in November, CMS reminds.Ophthalmology pra... Read more
Reader Question:
67912 Covers Gold Lid Weight Insertion
Question: How would I code for insertion of gold eyelid weights to correct lagophthalmos? ... Read more
Reader Question:
99214: Give Credit for Time Spent With Patient
Question: Our ophthalmologist spends a lot of time discussing treatment options, imaging r... Read more
Reader Question:
Can Provider Change Tax ID?
Question: One of our physicians wants to stop billing under the group's tax ID and start b... Read more
Reader Question:
Condition Doesn't Change Patient Status
Question: Our office saw a patient six months ago for a certain condition, and sent the pa... Read more
You Be the Coder:
Vitreous Strands
Question: Our ophthalmologist has performed a YAG laser for a diagnosis of "vitreous ... Read more
Strabismus:
67311-67318 Success Depends on Detailed Anatomy Understanding
How many muscles? Horizontal or vertical? The answers will keep your coding from getting c... Read more
ICD-10 Readiness:
Start Small When Prepping for ICD-10 Conversion, CMS Says
Acquaint yourself with the top 30 diagnoses that your practice sees and you'll get a head ... Read more
ABN:
You Must Use New Form by Nov. 1, CMS Says
Don't expect major changes, but you are required to switch.You should be used to the combi... Read more
Reader Question:
92235 Should Bring Full Pay Per Eye
Question: Can I report 92235 times two, bilateral eyes for each visit when the ophtha... Read more
Reader Question:
66170 Includes Trabeculectomy Suture Removal
Question: I am trying to bill for the removal of sutures the ophthalmologist placed d... Read more
Reader Question:
99241-99245 Requires You to Distinguish Consultation, Transfer of Care
Question: We commonly see patients referred by another physician. Our ophthalmologist perf... Read more
Reader Question:
99058 May Help You Collect Extra for Emergency Walk-Ins
Question: We recently hired a new podiatrist who is questioning whether we can bill a... Read more
Reader Question:
Know When to Bill Secondary Payer
Question: We have many patients with secondary insurance, some of which have deductib... Read more
You Be the Coder:
Silicon Oil Removal
Question:  Our ophthalmologist examined a patient who had recently had retinal repair... Read more
ICD-9 Coding:
368.8 Is Not Your Only Option for Nonspecific Complaints
Tip: Find the cause of 'blurred vision' to arrive at the correct diagnosis code ... Read more
ICD-10 Bridge
Once ICD-10 is implemented, the diagnosis codes in the above story will be different. Chec... Read more
Lesion Removals:
67840 or 11440? The Correct Answer Could Mean Over $100 for Your Practice
Documentation of the removal method is essential to picking the right code. When your ... Read more
Billing:
Prepare Now for Upcoming Version 5010 Challenges
The 2012 implementation deadline won't change, so now's the time to start preparing.Making... Read more
Reader Question:
15823 Receives Modifier to Break Bundle When Circumstances Warrant
Question: I started receiving denials for 15823 and 67904. To report this combo, should I ... Read more
Reader Question:
67210 and 67228 Cover 2 Photocoagulation Sessions Within 1 Global
Question: A patient presented with background diabetic retinopathy and retinal edema in he... Read more
You Be the Coder:
Botox-Induced Tarsorrhaphy
Question: We have a patient with a corneal ulcer and herpes zoster. To help the healing pr... Read more
CCI 17.2 Update:
67800-67850 Codes for Eyelid Excisions Now Include Automated Meibomian Gland Evacuation
You can break the bundles with modifier 59 -- but only in certain circumstances.If yo... Read more
CCI FAQs:
Puzzled By CCI Specs? We've Got Answers to Your Top 3 CCI Questions
Tip: Keep edits in mind for other payers besides Part B MACs.With the new round of Correct... Read more
Diagnosis Coding:
Get Ready to Specify Glaucoma Stages With New ICD-9 Codes
Tip: Start documenting clearer diagnoses now to prepare for ICD-10 in 2013.If you've felt ... Read more
Reader Question:
Rust Ring Removal
Question: Our ophthalmologist removed a rust ring from a patient's central cornea, using a... Read more
Reader Question:
99215 Won't Always Apply When Documentation Says 'Extended Visit'
Question: Can I use 99215 for an extended office visit?Florida SubscriberAnswer: You would... Read more
Reader Question:
Beware Modifier GZ Denials Starting July 1
Question: Which modifier applies when the physician performed a noncovered service for a M... Read more
Reader Question:
Check Medical Necessity Rules for 92025
Question: What are the rules are for coding corneal topography? I can't find a CPT&r... Read more
Reader Question:
Base VF Frequency on Disease Progress
Question: How often will Medicare allow visual field testing (92081-92083) on a patient?Ca... Read more
Reader Question:
Dates and Physician Presence Dictate 99221 Alone or With Office Visit
Question: Our physician saw a patient in the office, then admitted her to the hospital lat... Read more
Reader Question:
Beware of Repeat Laser Period
Question: A patient returns during the 90-day postoperative period of a focal laser for a ... Read more
You Be the Coder:
66180 and 67255 at Same Session
Question: Would it be appropriate to bill for both 66180 and 67255 at the same OR session ... Read more
Cataract Surgery:
66984 Bundling: 3 FAQs Test Your Coding Skills
Was the vitrectomy planned or unplanned? Know the answer before coding it separately.With ... Read more
When Is Cataract Removal 'Complex'?
When an ophthalmologist performs a particularly difficult complicated cataract extraction&... Read more
E/M Coding:
Stop Forfeiting Level Four and Five E/Ms With 3 PFSH Tips
Make your ophthalmologist's job easier by letting the patient or nurse document the histor... Read more
Aspects of PFSH
Per CPT, past family and social history is divided into three subsections.1. Past medical ... Read more
Reader Question:
E/M With 68761? Check Documentation First
Question: When the ophthalmologist does a comprehensive exam (92004) and decides to insert... Read more
Reader Question:
Consider Other Sources When CCI Doesn't Provide Info
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more
Reader Question:
Choose Lensectomy Code by Method
Question: Our ophthalmologist performed a pars plana vitrectomy, removing lens fragments f... Read more
You Be the Coder:
Diagnosis Code for Normal VF
Question: We had a patient present with high intraocular pressure, a sign of glaucoma, and... Read more
Diabetic Retinopathy:
67210 & 67228 Survival: Focus Your Focal Laser Coding to Stop DR Reimbursement Leaks
Key: The right ICD-9 codes and modifiers can bring your practice $1700 for bilateral PRP.A... Read more
Emergency Care:
99281-99285 and Ophthalmologists: Do They Go Together?
The rules say only one doctor gets to report 99281-99285 -- but it isn't always the E... Read more
Diagnostic Tests:
92225-92226 Mythbuster: Read This Before Reporting Extended Ophthalmoscopy Bilaterally
Learn the truth behind these common EO misconceptions and earn $25 per procedure.It's a co... Read more
Reader Questions:
Report Bleb Needling Separately Only in OR
Question: My ophthalmologist performed a needling procedure during the postoperative perio... Read more
Reader Questions:
Reserve 65235 for FBR in Facility
Question: A patient with glass in her cornea came into our office. The ophthalmologist rem... Read more
Reader Questions:
Cookie Cutter Appeal Letters Won't Bring in the Cash
Question: After checking to be sure we haven't made a coding or billing entry error, our p... Read more
Reader Questions:
Interpretation Equals 26 Regardless of POS
Question: A physician in a hospital-based clinic (not private practice) saw a patient fo... Read more
You Be the Coder:
Abandoned Photocoagulation
Question: After discussing the risks and benefits of both cryotherapy and photocoagulation... Read more
CCI 17.1:
65756 Update: Include Injections in DLEK, DSEK Coding
Virtually all of the nerve block injection codes are now bundled into endothelial keratopl... Read more
What Is EK?
Code 65756 (Keratoplasty [corneal implant]; endothelial) allows coders to specifically des... Read more
ICD-10 Prep:
Get to Know How Eye Infection Diagnoses Will Change in 2013
Hint: Your diagnosis coding will depend on which eye was infected once ICD-10 hits. Wh... Read more
Compliance:
Watch Out: OIG May Be Coming After Your Eye Global Surgery Fees
OIG discovered inconsistent billing for global eye surgery and believes adjustments could ... Read more
Denials Management:
Bust 4 Common Myths to Overcome MUE Denial Challenges
Ignore medically unlikely edits at your peril for claim rejection.Are you seeing more deni... Read more
Reader questions:
Office Visit OK With Vision Training
Question: Can we submit 99213 for an office visit and 92065 for vision training on the s... Read more
Reader questions:
Describe Follow-Up Visits Accurately With V Codes
Question: If a patient receives treatment and the condition was resolved, which ICD-9 code... Read more
Reader questions:
Don't Code Fundus Photos Bilaterally for Medicare
Question: Our new software program instructs us to append modifier 50 to code 92250, but I... Read more
Reader questions:
Differentiate 375.15 and 370.21 by Condition
Question: Can 375.15 and 370.21 be used interchangeably? When would one be the preferred d... Read more
You Be the Coder:
Pituitary Adenoma With VF Defect
Question: How would you code a visual field defect arising from pituitary adenoma?Florida ... Read more
A-Scans:
Make Your 76511 Claims Bulletproof With Accurate Bilateral, Modifier Reporting
Watch out: Different payers may have markedly different rules for coding.A-scan ultrasound... Read more
Glaucoma Screenings:
S0620 or G0117? Let Form and Severity Drive Your Glaucoma Coding Choice
If the patient presents with no complaints, you must consider the exam 'routine.'... Read more
Verify Supervision for Ophthalmic Ultrasound
Remember: Codes 76511-TC, 76512-TC, and 76513-TC (Ophthalmic ultrasound, diagnostic ...) a... Read more
Is Your Glaucoma Patient Truly at High Risk?
Medicare and most commercial insurances cover annual glaucoma screenings for high-risk i... Read more
PQRI:
Want to Show Your Exemption From the E-Prescribing Penalty? Use New G Codes, CMS Says
Three new codes show your MAC why you collect your full pay next year.Never fear -- i... Read more
Reader questions:
Shun 92310 for Therapeutic Contacts
Question: I'm having trouble getting non-Medicare carriers to reimburse the practice for t... Read more
Reader questions:
VF & Temp Plugs: How Many Modifiers?
Question: A patient came in for visual field (VF) tests. During the same visit, the ophtha... Read more
Reader questions:
Update Your Software and Billing With 2011 CPT Modifier Changes
Question: We read lots of information about CPT 2011 code changes, but are there any modif... Read more
You Be the Coder:
Dx for 'Foggy Vision'
Question: Many of our patients claim general reasons for their visit, such as "I can't see... Read more
Diagnostics:
362.51 Basics: Focus on 3 Key Areas to Keep Your AMD Claims on Track
Tip: Check CPT descriptors for 'one or more sessions' to keep your coding in compliance.Ne... Read more
Visual Fields:
92082 or 92083? Choose Wisely With This Expert Strategy
With over $70 on the line, don't risk submitting the wrong code or inadequate documentatio... Read more
Prove VF Necessity With Accurate ICD-9 Coding
Although your individual insurer may have its own rules for payment, here is a list of dia... Read more
Part B Mythbuster:
These 4 Deadly Myths Could Damage Your Practice
Setting your 92014 fees higher for Medicare patients could land your ophthalmology practic... Read more
Reader Questions:
Try V58.69 for Plaquenil Exam
Question: What diagnosis code should we use for OCT when the patient is currently on Pla... Read more
Reader Questions:
Dx for Post-LASIK Cataracts
Question: A patient who has had LASIK surgery now has cataracts. One of our ophthalmologis... Read more
Reader Questions:
Note Refraction Exclusion to Clarify ABN Confusion
Question: Are patients undergoing keratoconus workup or contact lens fitting still requi... Read more
Reader Questions:
Don't Mix Family History With Personal History
Question: My understanding has been that I cannot bill for "family history of" a condition... Read more
Reader Questions:
Stop Omitting 25 Because of Same Diagnosis
Question: I was recently told in a class that you do not need different diagnosis codes to... Read more
You Be the Coder:
EO for Flashers and Floaters
Question: A patient reports flashes and floaters but the ophthalmologist does not find evi... Read more
Blepharoplasty:
15820-15823 FAQ: Taking the Slack Out of Bleph Coding Could Recoup $300
Show the procedure isn't cosmetic with proper Dx coding and documentation. Don'... Read more
Code Only Once for 2 Visual Field Tests
Because your ophthalmologist performs the VF testing twice, you may be tempted to code the... Read more
ICD-9 Connection:
Show Medical Necessity for Blepharoplasty: Here's How
Diagnosis of a medical problem helps prove that eyelid procedure wasn't cosmetic.Each carr... Read more
Evaluation and Management:
99204-99205 Tips: Stop Letting ROS Conundrums Thwart Your Level 4 and 5 E/M Coding
Ensure you have documentation of each system -- or prepare to assign a lower code.Lev... Read more
Part B Payment:
CMS Tweaks 2011 Conversion Factor
Don't calculate fees using last year's rate -- changed RVUs should ensure that your p... Read more
Reader questions:
92225 Done Twice May Need Different Dxs
Question: Could you shed some light on billing 92225 or 92226 with modifier 50, RT/LT, o... Read more
Reader questions:
375.11 Is Dx Code for Damaged Ducts
Question: I am having trouble finding the proper diagnosis code for this claim. The ophtha... Read more
Reader questions:
Explore CCI, Fee Schedule for Modifier Details
Question: We sometimes get denials that appear to be related to bundling issues but I can'... Read more
Reader questions:
Double OV Codes May Spell Double Trouble
Question: One of our ophthalmologists saw a patient in the morning for a LASIK evaluation.... Read more
You Be the Coder:
Shunt Insertion With Graft
Question: Would it be appropriate to bill for both 66180 and 67255 at the same OR session ... Read more
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